Composition with polymer and ceramic and methods of use thereof

ABSTRACT

Provided herein are improved compositions and methods of making and using the same, the composition comprising a polymer and a ceramic present at a ratio of from 3:1 to 1:3 of polymer:ceramic by weight, wherein the composition comprises or is a composite of the polymer and the ceramic having improved printability and/or having an improved elastic modulus and/or improved stress at failure (e.g., as compared to a blend of the polymer and the ceramic). Improved medical implants incorporating the same are also provided.

STATEMENT OF GOVERNMENT SUPPORT

This invention was made with Government support under grant number W81XWH-14-2-0004 awarded by the Armed Forces Institute for Regenerative Medicine. The Government has certain rights to this invention.

BACKGROUND

Tricalcium phosphate (TCP) has been demonstrated in the literature to be similar to hydroxyapatite found in bone, and similarly promotes bone integration and regeneration. However, TCP is difficult to work with as an implant material. As a ceramic, it undergoes brittle fracture when loaded to failure. Implants fashioned from TCP also demonstrate an inability to withstand loading in bony defects.

Utilizing TCP particles as a part of a composite material has shown better performance. A polymer, such as polycaprolactone (PCL), can stabilize the composite under shear stress while TCP provides chemical and thermodynamic properties favorable for bone regeneration. PCL is a biodegradable polyester that has been utilized in medicine for many years, with applications in suture material, orthopedic implants, and degradable mesh devices.

However, to date, successful incorporation of TCP into PCL to form a useable material has been limited to 20% by weight. For example, Goh et al., J. Biomed. Materials Res. A, May 2014, vol. 102A, issue 5, reported the use of a PCL-TCP scaffold for bone regeneration and immediate dental implant comprised of 20% TCP by weight. It was reported that much of the scaffold was still present in vivo at 6 months, though a scaffold that degrades in about 5-6 months is considered ideal for bone regeneration and remodeling. In addition, minimal bone ingrowth was noted. See also Schumann et al., Chapter 6: Biomaterials/Scaffolds, in Methods in Molecular Medicine, 2nd ed.: Tissue Engineering (H. Hauser and M. Russenegger, eds., Humana Press Inc., Totowa, N.J.), which also describes use of a PCL-TCP mixture having 20% by weight TCP.

Although there have been reports in which a mixture of up to 50% by weight TCP blended with PCL was used in selective laser sintering (SLS) fabrication of scaffolds, it could not be used for experiments due to mechanical instability. See Lohfeld et al., Acta Biomaterialia, 8:3446-3456, 2012.

The use of a biodegradable polymer/ceramic composite during biofabrication also remains a challenge due to the interfacing of the material with the deposition/fabrication hardware because the materials must be sufficiently extrudable in order to be deposited.

U.S. Patent Application No. 2015/0037385 to Ramille Shah et al. discloses ink formulations comprising a high concentration of ceramic particles (at least 70 or at least 90 percent), a biocompatible polymer binder, optionally at least one bioactive factor, and one or more solvents, for room temperature three-dimensional printing. However, inclusion of a solvent in the bioink may be toxic to cells. In addition, biomaterials printed from the inks are hyperelastic, which may not be desirable for scaffolds that need a sufficient amount of stiffness such as for bone tissue.

Accordingly, there is a need for improved polymer ceramic compositions, especially those useful in three-dimensional biofabrication.

SUMMARY

Provided herein is an improved composition comprising, consisting of or consisting essentially of a polymer (e.g., a biocompatible polymer such as PCL), and a ceramic (e.g., a biocompatible ceramic such as TCP), the polymer and the ceramic present in the composition at a ratio of from 3:1 to 1:3 of polymer:ceramic by weight, and wherein the composition comprises or is a composite of the polymer and the ceramic having improved printability and/or having an improved elastic modulus and/or improved stress at failure (e.g., as compared to a blend of the polymer and the ceramic).

In some embodiments, the composite of polymer and ceramic has an internal microporous structure. In some embodiments, the composite of polymer and ceramic in the form of a 4 mm cube with 0.8 mm pores has an elastic modulus of from 15 to 25 MPa. In some embodiments, the composite of polymer and ceramic has an accelerated degradation as compared to a composite having a higher ratio of biocompatible polymer:biocompatible ceramic. In some embodiments, the composite of polymer and ceramic has increased water uptake as compared to a composite having a higher ratio of biocompatible polymer:biocompatible ceramic.

In some embodiments, the composition comprises less than about 10, 5, 3, 1, 0.5, or 0.1% of solvent (e.g., an organic solvent) by weight.

In some embodiments, the composition is provided as a filament useful for fused deposition modeling (FDM) three-dimensional printing. In some embodiments, the filament is provided on a spool. In some embodiments, the composition is provided as a powder or pellets useful for fused deposition modeling (FDM) three-dimensional printing. In some embodiments, the powder or pellets is provided in a cartridge.

Also provided is a medical implant (e.g., a bone implant) composition comprising a polymer (such as PCL), and a ceramic (such as TCP) as taught herein. In some embodiments, the implant is produced by fused deposition modeling (FDM) 3D printing.

In some embodiments, the implant includes: a porous core region (e.g., comprising interconnected pores of at least 200, 300, 400, 500, 600, 700, 800, 900, or 1,000 microns in diameter, such as from 400 microns to 1 millimeter average size of the interconnected pores); and a non-porous outer shell layer (e.g., comprising average pore sizes of less than 80, 50, 30, or 20 μm) surrounding said core region. In some embodiments, the non-porous outer shell layer is customized to be received in a bone defect of a patient based upon scan data (e.g., CT scan data). For example, a porous core region may include interconnected pores of at least 200 microns in diameter; and a non-porous outer shell layer may have average pore sizes of less than 80 μm, and surround at least a portion of said core region (e.g., configured such that the non-porous outer shell layer interfaces with surrounding soft tissue in a bone or cartilage defect and inhibits fibrous ingrowth therefrom).

In some embodiments, the porous core region comprises interconnected pores having an average diameter of from 400 microns to 1,000 microns; and/or the non-porous outer shell layer comprises average pore sizes of less than 50 microns.

In some embodiments, the implant is a bone implant. In some embodiments, the implant is a cartilage implant.

In some embodiments, the non-porous outer shell layer is customized to be received in a bone or cartilage defect of a patient based upon scan data (e.g., CT scan data).

Further provided is a method of making a composition comprising a composite of a polymer (e.g., a biocompatible polymer such as PCL), and a ceramic (e.g., a biocompatible ceramic such as TCP), wherein the polymer and ceramic are present in the composition at a ratio of from 3:1 to 1:3 of biocompatible polymer:biocompatible ceramic by weight, the method comprising one or more of the steps of: providing an organic solvent with the biocompatible polymer dissolved therein, adding the biocompatible ceramic to the organic solvent, wherein the biocompatible ceramic has an average particle size of about 100 nanometers, and wherein the organic solvent is at a temperature of 20-60° C., to form a mixture of the biocompatible polymer and the biocompatible ceramic, sonicating the mixture of the biocompatible polymer and the biocompatible ceramic (e.g., at a frequency of 15 or 20 to 25 or 30 kHz), to form a sonicated mixture, and drying the sonicated mixture to form said composition.

In some embodiments, providing the organic solvent with the polymer dissolved therein comprises one or more of the steps of: mixing the biocompatible polymer with an organic solvent, and heating the organic solvent to its boiling point until the biocompatible polymer dissolves.

In some embodiments, drying the sonicated mixture comprises one or more of the steps of: drying the sonicated mixture in a vacuum oven, cryomilling the sonicated mixture to form a powdered composition, and then drying the powdered composition in a vacuum oven.

Also provided is method of making a medical implant, said method comprising printing a composition as taught herein. In some embodiments, the printing comprises melt extrusion such as fused deposition modeling, e.g., fused deposition modeling through a nozzle that is from 50 microns to 300 microns in size. In some embodiments, the method comprises co-printing a composition comprising cells in a biocompatible carrier (e.g., a hydrogel) onto the scaffold.

Further provided is a method of treating a bone or cartilage defect or injury in a subject in need thereof, comprising implanting a medical implant composition as taught herein into the subject in a treatment-effective configuration. Also provided is the use of a medical implant composition as taught herein for treating a bone or cartilage defect of injury in a subject in need thereof, or for the preparation of a medical implant for treating a bone or cartilage defect or injury.

The foregoing and other objects and aspects of the present invention are explained in further detail in the drawings herein and the specification set forth below. The disclosures of all United States Patent references cited herein are incorporated by reference herein in their entirety.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a photograph demonstrating how the solvent/milling method as taught herein results in larger PCL particles. On the Left is shown particles resulting from the Solvent/Milling method (SM), and on the Right is particles from the Cryo-milling (CM) alone. The TCP particles suspend, while the larger PCL particles sink.

FIG. 2 is a magnified image of composite PCL/TCP particles generated by process including solvent blending step.

FIG. 3 is a magnified image of particles of TCP aggregating without evidence of incorporated PCL after the cryo-mill blending.

FIG. 4 shows improved elastic modulus and stress at failure of the SM particles as compared to the CM.

FIG. 5A is an image showing the TCP Loading Effect on PCL composite structure of the material.

FIG. 5B is another image showing the TCP Loading Effect on PCL. Scanning electron micrographs of printed structures of 100% PCL, PCL/TCP (20% TCP), PCL/TCP (50% TCP). Surface morphology changed with increasing TCP content, including evidence of calcium phosphate exposure on the surface. Structures were immersed in liquid nitrogen and fractured to visualize the cross section of printed filaments. Increased TCP particles were visualized as well as a morphologic change of the inner structure. PCL and 20% TCP had similar surface morphology with polygonal grain-like patterns. 50% TCP had an amorphous surface morphology with irregular bumpy protrusions. 50% TCP had observable white specked surface and occasional fractal like patterns, as seen in 1,500× image. 20% TCP had white specked surface with obviously fewer per viewing area. White specks may be TCP particles near the surface altering electron reflection. These specks were also seen in the cross section which also revealed a unique micropore architecture in the 50% TCP.

FIG. 6 presents the results of compression, Young's modulus and yield strength on test structures of the materials that were 3D printed as 4 mm cubes. Compression tests were performed on an Instron universal testing system at 1 mm/mm to 25% compression.

FIG. 7A: Accelerated degradation—SEM: SEM micrographs show surface changes after 24 hrs in 1 N NaOH for accelerated degradation. Panel A: PCL; Panel B: PCL/TCP (20% TCP); Panel C: PCL/TCP (50% TCP). Scale bar—10 μm.

FIG. 7B: Accelerated degradation—Mass: measurements of mass confirm accelerated degradiation of the 50% TCP test structures.

FIG. 7C: Accelerated degradation—Mechanical: Mechanical properties of 4 mm cube structures were evaluated after accelerated degradation for 24, 48 and 72 hrs in 1N NaOH. By 48 hours, the 50% TCP structure collapsed under its own weight, while the PCL and 20% TCP structures maintained their respective properties.

FIG. 8: Water Uptake: Printed PCL structures of 20% and 50% TCP were submerged in water to assess hydrophilic water uptake. 50% TCP demonstrated higher water uptake on average.

FIG. 9: Graft design and printed results. a) Mandible region of defect identified. b) Biomimetic graft design consisted of a Core (C) with or without a contoured Shell (S). c) The graft was held in place by a 5 Plate (P) contoured to the mandible. d) Complex shapes were supported during printing by a Support Base (B). e) The control graft had no Shell structure, only a heterogeneous porous architecture. f) After printing, the Base was removed and the graft sterilized for implantation.

FIG. 10: Tissue ingrowth results. The image slices along the long axis of the graft were aligned by center point and the percentage of Core segmentation overlapping with new bone segmentation was calculated for each slice and charted against distance from graft center. New bone in biomimetic grafts consistently fills more area along the length of the graft.

FIG. 11: Data captured by digital segmentation assisted assessment of bone formation within the graft. a) The average radiographic density within the digital volume of the Core in Core-Only graft recipients with the combined average of all individuals plotted as a solid line, b) the average radiographic density within the Core region of the Core/Shell graft recipients with associated average of all individuals plotted as a solid line, c) the Core-Only and Core/Shell combined averages overlaid, and d) the combined averages of radiographic density of segmented new bone tissue within the Core region of respective grafts shows that Core-Only bone tissue is reaching a plateau in density while the Core/Shell is progressing linearly. Both are forming bone and moving towards average contralateral value plotted as black solid line.

DETAILED DESCRIPTION OF EMBODIMENTS

The present invention is now described more fully hereinafter with reference to the accompanying drawings, in which embodiments of the invention are shown. This invention may, however, be embodied in different forms and should not be construed as limited to the embodiments set forth herein; rather these embodiments are provided so that this disclosure will be thorough and complete and will fully convey the scope of the invention to those skilled in the art.

The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used herein, the singular forms “a,” “an” and “the” are intended to include plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises” or “comprising,” when used in this specification, specify the presence of stated features, integers, steps, operations, elements components and/or groups or combinations thereof, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components and/or groups or combinations thereof.

The transitional phrase “consisting essentially of” means that the scope of a claim is to be interpreted to encompass the specified materials or steps recited in the claim, and those that do not materially affect the basic and novel characteristic(s) of the claimed invention.

Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs: It will be further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of the specification and claims and should not be interpreted in an idealized or overly formal sense unless expressly so defined herein. Well-known functions or constructions may not be described in detail for brevity and/or clarity.

As used herein, “biocompatible” means that the substance is not unduly harmful, e.g., not unduly toxic, injurious, physiologically reactive and/or causing immunological rejection, to living tissue when used for treatment as taught herein.

Polymers

Polymers that may be used in accordance with embodiments of the present invention may be any suitable biocompatible polymeric material, including biodegradable or bioerodible polymers, or polymers that are stable or inert in vivo. Examples include, but are not limited to, poly(lactic acid) polymers, poly(glycolic acid) polymers, poly(lactide-co-glycolides) (PLGA), poly(urethanes), poly(siloxanes) or silicones, poly(ethylene), poly(vinyl pyrrolidone), poly(2-hydroxy ethyl methacrylate), poly(N-vinyl pyrrolidone), poly(methyl methacrylate), poly(vinyl alcohol) (PVA), poly(acrylic acid), poly(vinyl acetate), polyacrylamide, poly(ethylene-co-vinyl acetate), poly(ethylene glycol), poly(methacrylic acid), polylactic acid (PLA), polyglycolic acids (PGA), nylons, polyamides, polyanhydrides, poly(ethylene-co-vinyl alcohol) (EVOH), polycaprolactone, poly(vinyl acetate), polyvinylhydroxide, poly(ethylene oxide) (PEO), and polyorthoesters or a co-polymer formed from at least two members of the group. In some embodiments, the polymer comprises, consists of or consists essentially of an aliphatic polyester.

In some embodiments, the polymer is poly-L-lactic acid, poly(glycolic acid), polycaprolactone, polystyrene, polyethylene glycol, or a copolymer thereof (such as poly(lactic-co-glycolic acid)). In some embodiments, the polymer is polycaprolactone (PCL).

Ceramics

Examples of suitable ceramic materials that may be used in accordance with embodiments of the present invention include, but are not limited to, tetracalcium phosphate, tricalcium phosphate, calcium alkali phosphate ceramic, calcium phosphorus apatite, bioglass, calcium carbonate, calcium hydroxide, calcium oxide, calcium fluoride, calcium sulfate, magnesium hydroxide, hydroxyapatite, calcium phosphorus apatite, magnesium oxide, magnesium carbonate, magnesium fluoride, silver nanoparticles, carbon-based nanoparticles (e.g., carbon nanotubes), allograft bone, and mixtures thereof. See, e.g., U.S. Pat. Nos. 6,869,445 and 5,281,265.

In some embodiments, the ceramic comprises hydroxyapatite, tricalcium phosphate, or a mixture thereof. In some embodiments, the ceramic is tricalcium phosphate (TCP).

In some embodiments, the ceramic is in the form of nanoparticles. In some embodiments, the ceramic has an average particle size of from 10, 20, 30, 40 or 50 nanometers to 80, 90, 100, 200, 300 or 400 nanometers. In some embodiments, the ceramic has an average particle size of up to 1 micron.

Compositions and Methods of Use

Provided herein are compositions comprising a biocompatible polymer and a biocompatible ceramic. In some embodiments, the biocompatible polymer and biocompatible ceramic are present in the composition at a ratio, by weight, of from 3:1 to 1:3 of biocompatible polymer:biocompatible ceramic. In some embodiments, the biocompatible polymer and biocompatible ceramic are present in the composition at a ratio, by weight, of from 2:1 to 1:2 of biocompatible polymer:biocompatible ceramic. In some embodiments, the biocompatible polymer and biocompatible ceramic are present in the composition at a ratio, by weight, of from 1.5:1 to 1:1.5 of biocompatible polymer:biocompatible ceramic. In some embodiments, the biocompatible polymer and biocompatible ceramic are present in the composition at a ratio, by weight, of 1.25:1 to 1:1.25 of biocompatible polymer:biocompatible ceramic. In some embodiments, the biocompatible polymer and biocompatible ceramic are present in the composition at a ratio, by weight, of 1:1 of biocompatible polymer:biocompatible ceramic.

The composition may be tailored or adjusted to achieve mechanical properties suitable for desired tissue treatment. For example, a ratio of PCL:TCP of approximately 1:1 by weight may be able to achieve a compression modulus similar to trabecular bone.

In some embodiments, the composition is provided as composite of a biocompatible polymer and a biocompatible ceramic (e.g., composite particles thereof). “Composite” as used herein refers to the polymer and ceramic being combined in such a way that the ceramic is substantially incorporated (e.g., intercalated) into the polymer (see FIGS. 5A-5B). In some embodiments, the composite has an improved (i.e., higher) elastic modulus and/or improved (i.e., higher) stress at failure as compared to a blend of said biocompatible polymer and said biocompatible ceramic wherein the ceramic is not substantially incorporated into the polymer (see FIG. 3). For example, a melt-pressed sheet of the composite may have an elastic modulus of from 1200 or 1300 MPa to 1500 or 1600 MPa under tensile loading, and/or a stress at failure of from 5000 or 6000 kPa to 8000, 9000 or 10000 kPa. As another example, a 4 mm cube with 0.8 mm pores may have an elastic modulus of from 15 to 25, 27 or 30 MPa under compressive loading. Having these improved properties such as a higher elastic modulus may be desirable in the formed scaffold based upon the tissue to be modeled, healed or augmented, such as bone or cartilage tissue.

In some embodiments, the composite of polymer and ceramic has improved printability (e.g., printing at higher print speeds and/or resolution) as compared to a blend of the polymer and ceramic. For example, in some embodiments the composition has rheological properties such that it is extrudable through a 300, 200, 100, or 50 micron nozzle of, e.g., a fused deposition modeling (FDM) system. By “extrudable” is meant the composition is consistently usable with the nozzle without significant and/or frequent failure such as, e.g., clogging the nozzle.

In some embodiments, the composite of polymer and ceramic has an internal microporous structure. In some embodiments, the micropores are an average of from about 1 or 5 microns to about 30, 50 or 100 microns in diameter.

In some embodiments, the composition comprises less than about 10, 5, 3, 1, 0.5, or 0.1% of solvent (e.g., an organic solvent) by weight.

Compositions of the invention may optionally include additional ingredients such as, e.g., growth factors, antibiotics, etc. “Antibiotic” as used herein includes any suitable antibiotic, including, but not limited to, cefazolin, vancomycin, gentamycin, erythromycin, bacitracin, neomycin, penicillin, polymycin B, tetracycline, biomycin, chloromycetin, streptomycin, ampicillin, azactam, tobramycin, clindamycin, gentamicin and combinations thereof. See, e.g., U.S. Pat. No. 6,696,073. In some embodiments, the antibiotic is a water soluble antibiotic.

Compositions taught herein may be provided in the form of products suitable for use in three-dimensional printing or extrusion devices, such as fused deposition modeling (FDM). In some embodiments, the composition is provided in the form of a filament having a diameter of, for example, from 1 or 2 millimeters to 5, 8 or 10 millimeters, and/or a length of, for example, from 1, 2 or 5 meters to 20, 50 or 100 meters. In some embodiments, the filament is provided on a spool. In some embodiments, the composition is provided as pellets (e.g., having a diameter of from 1 or 2 millimeters to 5, 8 or 10 millimeters). In some embodiments, the composition is provided as a powder. In some embodiments, the pellets or powder is provided in a cartridge.

Extrudable compositions may be used with any suitable deposition apparatus, including, but not limited to, that described in Kang et al., US 2012/0089238.

In some embodiments, the depositing step is a patterned depositing step; that is, deposition is carried out so that the deposited composition is deposited in the form of a regular or irregular pattern, such as a regular or irregular lattice, grid, spiral, etc. See, e.g., Kang et al., US 2012/0089238; Teoh et al., U.S. Pat. No. 8,702,808; and Teoh et al., U.S. Pat. No. 6,730,252.

In some embodiments, the deposition apparatus includes and/or is operatively associated with a computer-aided drafting and/or computer aided manufacturing (CAD/CAM) system to design the products to be created or convert images to a product design, control the dispensers, XYZ axis positioning, and/or other functions. Such CAD/CAM systems are known to those skilled in the art and can be implemented in combination with the present invention in accordance with known techniques or variations thereof that will be apparent to those skilled in the art. See, e.g., U.S. Pat. Nos. 7,472,044; 7,413,597; 7,308,386; 6,804,568; 6,775,581; 6,773,713; 6,594,539; 6,379,593; 5,930,152; and 5,757,649; the disclosures of which are incorporated by reference herein in their entirety.

Compositions as taught herein may be provided (e.g., by being printed, melted or molded) in the form of a scaffold useful for bone and/or cartilage regeneration, including composite tissues such as the osteotendinous junction, osteoligamentous, osteochondral interface, etc. Such scaffolds may, accordingly, be used in methods of treatment for bone and/or cartilage injuries such as breaks, tears, fractures, etc., inclusive of injuries due to surgical procedures (e.g., tumor removal) and/or for dental or facial treatment or cosmetic procedures.

“Bone” as used herein includes any bone or bone tissue, such as, for example: the pelvis; long bones such as the tibia, fibia, femur, humerus, radius, and ulna, ribs, sternum, clavicle, skull, mandible, etc. Other craniofacial bones include, but are not limited to, the inferior nasal concha, lacrimal bone, maxilla, nasal bone, palatine bone, vomer, zygomatic bone, alveolar ridge, etc.

“Fracture” or “break” as used herein with respect to bones includes any type thereof, including open or closed, simple or compound, comminuted fractures, and fractures of any location including diaphyseal and metaphyseal. “Fracture” as used herein is also intended to include defects such as holes, gaps, spaces or openings, whether naturally occurring, the result of trauma or surgically induced (e.g., by surgical removal of undesired tissue from bone).

In some embodiments, the scaffold may be seeded with cells during (e.g., by co-printing) or after the biofabrication. Such cells may include, but are not limited to, mammalian cells (e.g., dog, cat, primate, human), including stem cells (e.g., embryonic, amniotic fluid, etc.), progenitor cells and differentiated cells. Particular examples include, but are not limited to, chondrocytes, tenocytes, odontoblasts, and osteoblasts, as well as progenitors thereof.

Stem cells have the ability to replicate through numerous population doublings (e.g., at least 60-80), in some cases essentially indefinitely, and also have the ability to differentiate into multiple cell types (e.g., is pluripotent or multipotent). It is also possible for cells to be transfected with a compound of interest that results in the cells becoming immortalized (i.e., able to double more than 50 times). For example, it has been reported that mammalian cell transfection with telomerase reverse transcriptase (hTERT) can immortalize neural progenitor cells (See U.S. Pat. No. 7,150,989 to Goldman et al.).

“Embryonic stem cell” as used herein refers to a cell that is derived from the inner cell mass of a blastocyst and that is pluripotent.

“Amniotic fluid stem cell” as used herein refers to a cell, or progeny of a cell, that (a) is found in, or is collected from, mammalian amniotic fluid, mammalian chorionic villus, and/or mammalian placental tissue, or any other suitable tissue or fluid from a mammalian donor, (b) is pluripotent; (c) has substantial proliferative potential, (d) optionally, but preferably, does not require feeder cell layers to grow in vitro, and/or (e) optionally, but preferably, specifically binds c-kit antibodies (particularly at the time of collection, as the ability of the cells to bind c-kit antibodies may be lost over time as the cells are grown in vitro).

“Pluripotent” as used herein refers to a cell that has complete differentiation versatility, e.g., the capacity to grow into any of the animal's cell types. A pluripotent cell can be self-renewing, and can remain dormant or quiescent with a tissue. Unlike a totipotent cell (e.g., a fertilized, diploid egg cell) a pluripotent cell cannot usually form a new blastocyst.

“Multipotent” as used herein refers to a cell that has the capacity to grow into any of a subset of the corresponding animal cell types. Unlike a pluripotent cell, a multipotent cell does not have the capacity to form all of the cell types of the corresponding animal.

“Cartilage cells” include those cells normally found in cartilage, which cells include chondrocytes. “Chondrocytes” produce and maintain the extracellular matrix of cartilage, by, e.g., producing collagen and proteoglycans. Cartilage is a highly specialized connective tissue found throughout the body, and its primary function is to provide structural support for surrounding tissues (e.g., in the ear and nose) or to cushion (e.g., in the trachea and articular joints). Types of cartilage include hyaline cartilage (articular joints, nose, trachea, intervertebral disks (NP), vertebral end plates), elastic cartilage (tendon insertion site, ligament insertion site, meniscus, intervertebral disks (AP)), costochondral cartilage (rib, growth plate), and fibrocartilage (ear). The loss of cartilage in a subject can be problematic, as it has a very limited repair capacity.

“Mesenchymal stem cells” or “MSCs” are progenitors of chondrocytes. MSCs can also differentiate into osteoblasts. Cartilage cells/tissues used with the compositions described herein are useful for, among other things, implantation into a subject to treat cartilage injury or disease.

“Bone cells” include those cells normally found in bone, and include osteoblasts, osteoclasts, osteocytes, and any combination thereof. Bone cells/tissues used with the compositions described herein are useful for, among other things, implantation into a subject to treat bone fractures or defects, and/or promote bone healing.

Cells may be syngeneic (i.e., genetically identical or closely related, so as to minimize tissue transplant rejection), allogeneic (i.e., from a non-genetically identical member of the same species) or xenogeneic (i.e., from a member of a different species). Syngeneic cells include those that are autogeneic (i.e., from the subject to be treated) and isogeneic (i.e., a genetically identical but different subject, e.g., from an identical twin). Cells may be obtained from, e.g., a donor (either living or cadaveric) or derived from an established cell strain or cell line. For example, cells may be harvested from a donor (e.g., a potential recipient of a medical implant composition) using standard biopsy techniques known in the art.

In some embodiments, one or more active or therapeutic agents can be included in the composition or scaffold made therefrom. The same or different agents can be included in different regions. Any suitable active agent (e.g., in an amount to facilitate the growth and/or differentiation of cells) can be used. Examples include, but are not limited to, transforming growth factor-alpha (TGF-alpha), transforming growth factor-beta (TGF-beta), platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), nerve growth factor (NGF), brain derived neurotrophic factor, cartilage derived factor, bone growth factor (BGF), basic fibroblast growth factor, insulin-like growth factor (IGF), vascular endothelial growth factor (VEGF), granulocyte colony stimulating factor (G-CSF), hepatocyte growth factor, glial neurotrophic growth factor (GDNF), stem cell factor (SCF), keratinocyte growth factor (KGF), and skeletal growth factor. Stromal-derived factor (SDF), peptides such as substance P (SP), agrin, small molecules such as adenosine, etc. See, e.g., U.S. Pat. No. 7,531,503.

“Subjects” who may be treated with scaffolds made in accordance with the present invention are generally human subjects and include, but are not limited to, “patients.” The subjects may be male or female and may be of any race or ethnicity, including, but not limited to, Caucasian, African-American, African, Asian, Hispanic, Indian, etc. The subjects may be of any age, including newborn, neonate, infant, child, adolescent, adult and geriatric subjects.

Subjects may also include animal subjects, particularly vertebrate subjects, e.g., mammalian subject such as canines, felines, bovines, caprines, equines, ovines, porcines, rodents (e.g., rats and mice), lagomorphs, non-human primates, etc., or fish or avian subjects, for, e.g., veterinary medicine and/or research or laboratory purposes. “Treat” refers to any type of treatment that imparts a benefit to a subject, e.g., a patient afflicted with a trauma or a disease resulting in loss or damage to bone and/or cartilage, including dental or other tissue reconstruction. For example, arthritis is a disease that affects cartilage. Treating includes actions taken and actions refrained from being taken for the purpose of improving the condition of the patient (e.g., the relief of one or more symptoms), delay in the onset or progression of the disease, etc. In some embodiments, treating includes reconstructing bone and/or cartilage tissue (e.g., where such tissue has been damaged or lost by injury or disease) by implanting a scaffold into a subject in need thereof. Scaffolds may be implanted, e.g., at or adjacent to the site of injury, and/or at another site in the body of a subject that would impart a benefit to the subject, as would be appreciated by one of skill in the art. Scaffolds or implants may also be used in treatment for cosmetic or plastic surgery purposes.

In some embodiments, scaffolds as taught herein may be resorbable in vivo over a time of from 1 month to 6 months, e.g., from 1, 2, 3, 4 or 5 to 6 months, from 1, 2, 3 or 4 to 5 or 6 months, from 1, 2 or 3 to 4, 5 or 6 months, or from 1 or 2 to 3, 4, 5 or 6 months.

In some embodiments, the fabricated constructs are composed of two parts: 1) a cell-containing gel or hydrogel structure and 2) a solidified polymer or polymer-based composite or structural polymer scaffold, as taught herein. The polymer scaffold provides such a frame to protect the cell-contained gel structure from external loads or disruption. See Kang et al., US Patent Application Pub. No. US 2012/0089238, which is incorporated by reference herein in its entirety.

Methods of Making Extrudable Compositions

Provided herein are methods of making a composition comprising a biocompatible polymer and a biocompatible ceramic, wherein said composition is extrudable. In some embodiments, the method includes one or more of: providing an organic solvent with the biocompatible polymer dissolved therein, adding the biocompatible ceramic, wherein the organic solvent is at a temperature of, for example, 20 to 60 degrees Celsius (depending on the strength of the solvent, melting point of the polymer and boiling point of the solvent) to form a mixture of the biocompatible polymer and the biocompatible ceramic, sonicating the mixture of the biocompatible polymer and the biocompatible ceramic at a frequency of, for example, 10, 15 or 20 to 25, 30 or 40 kilohertz (kHz), to form a sonicated mixture, and drying the sonicated mixture to form the composition.

In some embodiments, providing the organic solvent with the biocompatible polymer dissolved therein may include one or more of the steps of: mixing the biocompatible polymer with an organic solvent, heating the organic solvent to its boiling point (e.g., refluxing) until the biocompatible polymer dissolves, to thereby provide the organic solvent with the biocompatible polymer dissolved therein.

In some embodiments, drying the sonicated mixture may comprise one or more of the steps of: drying the sonicated mixture in a vacuum oven, cryomilling the sonicated mixture to form a powdered composition, and then drying the powdered composition in a vacuum oven, to thereby dry the sonicated mixture.

The present invention is explained in greater detail in the following non-limiting examples.

EXAMPLES Example 1: Example Method of Making PCL-TCP Composite Via Solvent/Milling Method (SM)

-   -   In a glass beaker with a stir bar, mix PCL with organic solvent         (e.g., chloroform or acetone) (e.g., 10 grams of PCL and 100 mL         solvent)     -   While stirring, cover and heat to boiling point and leave at a         simmering level until PCL dissolves completely (stir bar can be         set to about 60-100 rpm)     -   Continue stirring while adding TCP powder (e.g., nano powder—100         nm average particle size)     -   Allow to mix thoroughly with stir bar     -   Remove from heat/stirring and insert sonicator horn     -   Sonicate for about 1-3 minutes     -   Return to stirring with stir bar     -   Leave partially covered until stir bar no longer overcomes         viscosity     -   Place container in vacuum oven overnight (used 45° C. and −12         psi)     -   Cryomill material (5-3 min cycles at 10c/s)     -   Dry thoroughly in vacuum oven overnight     -   Powder is ready for 3D printing or filament fabrication

Example 2: Example Comparison of PCL/TCP Materials

TEM and tensile data indicate material difference based on PCL/TCP blend method. Both materials are 1:1 PCL/TCP (wt. %).

Example 3: TEM of Material Powder in Ethanol Suspension

As shown in FIGS. 1-3, the Solvent/Milling method (SM) results in a powder with composite particles, whereas Cryo-milling (CM) alone (physical blend of PCL and TCP that is simply cryomilled together) appears to produce a powder with two distinct phases. Ethanol suspensions were distinct. CM suspension produced mainly TCP aggregates, while SM did not suspend well and particles appear to be composite in nature.

Example 4: Tensile Test of Melt-Pressed Sheet

Melt-pressed sheets were cut into dog bone test specimens and destructively tested in tensile loading. Sheets were produced by pressing 2 g of powder between heated platens in a hydraulic press. Platens were heated to 120° C. and powder was allowed to preheat for 5 minutes prior to application of pressure up to 2 metric tons then removed and cooled to room temperature. Sheets measured 150-200 m in thickness. A dog bone shaped punch was used to stamp out tensile specimen from the sheets. This fabrication method represents melt-extrusion printing or laser sintering fabrication. The resulting data shown in FIG. 4 indicates better performance from the SM material by means of higher Elastic Modulus and higher Stress at Failure.

Example 5: Example Use of PCL-TCP Composition for Bioprinted Calvarial Bone Reconstruction

Bioprinted constructs for calvarial bone reconstruction were formed of PCL doped with tricalcium phosphate (TCP) nanoparticles (Berkeley Advanced Biomaterials, Berkeley, Calif.) at a 1:1 ratio by weight, with cell-laden hydrogel dispensed in an interleaved crosshatch pattern. The mixture of PCL and TCP was printed through a 200-μm diameter nozzle (TECDIA Inc., Campbell, Calif.) with 780 kPa compressed air. These materials were heated to 112° C. in the heating chamber of the Integrated Tissue/Organ Printing system (ITOP) to produce a beam width of 200 μm. The printed PCL/TCP architecture provided an internal porosity of approximately 70%. The top and bottom surfaces of the construct were printed with beam heights of 50 μm and 220 μm pitch resulting in 100 μm thick region of low porosity to minimize host cell infiltration.

Cell-laden hydrogel was printed within the internal pores of the PCL/TCP structure, which was produced with 115 μm beam height and 670 μm pitch with repeating layers such that resultant wall heights reached 345 μm. The cell-laden hydrogel was composed of 5×10⁶ human amniotic fluid stem cells (hAFSCs) per ml of the hydrogel and printed through a 300 μm diameter Teflon-lined needle nozzle (Musashi Engineering Inc.) at 60 kPa. After printing, constructs were treated with a thrombin solution to induce fibrinogen conversion to fibrin, as well as osteogenic culture conditions. Constructs were incubated in osteogenic differentiation media for 10 days before implantation.

Results. To study maturation of bioprinted bone in vivo, rat calvarial bone constructs were fabricated in a circular shape (8 mm diameter×1.2 mm thickness) with hAFSCs cultured in osteogenic media for 10 days, and then implanted in a calvarial bone defect region of Sprague Dawley rats (n=4). Constructs were analyzed 5 months after implantation. The bioprinted constructs showed newly-formed vascularized bone tissue throughout the implants, including the central portion, with no necrosis, whereas the untreated defect and scaffold-only treated control groups showed fibrotic tissue ingrowth and minimal bone tissue formation restricted to the periphery of the implant, respectively. The modified Tetrachrome staining confirmed mature bone and osteoid formation. Von Willebrand factor (vWF) immunostaining showed large blood vessel formation within newly formed bone tissue throughout the bioprinted bone constructs, including the central portion, whereas the nontreated and scaffold-only groups had only limited vascularization restricted to the periphery of the implant.

See also Kang et al., “A 3D bioprinting system to produce human-scale tissue constructs with structural integrity,” Nature Biotechnology 34:312-319 (2016).

Example 6: 3D Printed Structures of PCL with Variations of TCP Loading

Shown in FIGS. 5A and 5B are images of 3D printed structures of polycaprolactone with increasing loading of tricalcium phosphate (TCP) nanoparticles. TCP was incorporated, as described above, by mixing into a solution of polycaprolactone dissolved in an organic solvent. The solvent was then evaporated and the composite milled into a powder. The powder was loaded into a steel cartridge, heated to 120° C., and printed via pneumatic pressure (1.5 MPa). Structures were collected after printing, submerged in liquid nitrogen, and subjected to brittle fracture to observe the cross-section of the printed filaments.

The increase from neat PCL to 20% TCP (wt %) appears similar in surface and cross-sectional morphology. TCP particles can be observed near the surface at the 20% level. The high TCP content of 50% alters the microstructure of the material comprising the filaments as seen in the images. With no other alterations, the material exhibits an internal microporous structure. Increased numbers of TCP particles are seen at the filament surface and throughout the cross-section.

Example 7: Bone Grafts with Improved Form and Function

A biomimetic graft design, based on the architectural arrangement of bone, was tested that provides a porous Core for bone in-growth and a dense Shell resisting fibrous tissue in-growth. Findings support enhancement of bone regeneration in a graft designed to minimize competing fibrotic tissue forming in the defect. By focusing on material of clinical relevance and biomimetic design aspects, an effective graft design promotes bone regeneration in the proper shape, without the need for stem cells or growth factors, in a clinically relevant animal model.

Calcium phosphate ceramics (CaP) have proven beneficial for bone tissue regeneration, and methods have been developed to form 3D structures from CaP materials by shaping a composite with CaP as a major component and a polymeric matrix. In some cases, the object is heated to burn off the matrix such that the final product is completely CaP. The benefit of removing the matrix seems to be solely for improved biological response driven by interactions with CaP without interfering polymer which may not be biodegradable. The most common manufacturing method for these structures are light-based printing (either stereolithography or selective laser sintering, STL and SLS respectively) since CaP extrusion can be problematic. Such scaffolds are brittle and cannot be printed with other materials and cells.

Other methods like fused deposition modeling (FMD) and drop-on-demand can produce structures composed of multiple materials. For tissue engineering, regenerative medicine, and other biology-based sciences, multiple materials spatially arranged in precise patterns is desirable. Therefore, a composite material containing CaP that can be dispensed in a 3D printing modality compatible with printing other biomaterials and cells remains a need in fields working with engineered bone tissue.

To date, TCP and hydroxyapatite (HAP) have been incorporated into biocompatible polymers for FDM like poly(ε-caprolactone) PCL and poly(L-lactide) PLLA; however, the ratio of incorporation is typically lower than 30%, (wt.) or rendered too brittle to be useful. These composites have properties amenable to bone tissue engineering in vitro or in simple in vivo bony defects such as a calvaria defect. However, there is also evidence that such a low ratio may be insufficient to support reliable bone regeneration. The materials should also be printable with other materials, especially cell-laden materials, to construct a 3D structure that would be sufficiently stable for in vitro culture and in vivo implantation.

A composite material was formulated with CaP that is printable alongside cellular materials, biodegradable, and biocompatible. Polymers considered for the matrix were poly(L-lactide) (PLLA) and poly(ε-caprolactone) (PCL) since they are FDA approved, biodegradable, biocompatible, and can be melt extruded. PLLA has a melting point around 150° C., while PCL melts around 60° C. It was anticipated that melt extrusion temperature would increase once CaP filler was added to make the composite material, making the use of PLLA as the composite matrix impractical as it would be extruded on or next to cell-laden materials. Heat related damage in this scenario was already tested with PCL at temperatures well above the melting point, so PCL was chosen as the matrix component.

Composite Mixing and Printing.

Polycaprolactone (43-50 kDa, Polysciences Inc., USA) was dissolved in warm acetone (Fisher Scientific, USA) at 60° C. CaP nano-powders HAP and TCP (Berkeley Advanced Biomaterials, USA) were weighed and added to PCL solution. The mixture was allowed to mix thoroughly with stirring and sonication for up to 1 hour. Mixture was moved to a vacuum oven at 40 C and −25 in.Hg for 24-48 hours to remove acetone. After no hint of acetone was discernable, the material was ground in a cryogenic mill (SPEX Freezer/Mill, USA) for 10 cycles of 3 minutes or until no pieces larger than 0.5 cm were visible. The powder was returned to the vacuum oven for 24 hours to ensure removal of solvent and condensate.

Powdered composite material was placed in a steel 10 cc syringe with affixed 200 μm nozzle (ARQUE-S, TECDIA, Japan) in the ITOP system. Material was then heated up to 150° C. and 5 extruded at 1.5 MPa air pressure. Pure PCL material was printed likewise at 95° C. and 750 kPa. Various structures were printed for evaluation. A 4-mm cube structure with 800 μm square pores was printed for mechanical testing, accelerated degradation and SBF immersion. Disk structures (15 mm or 22 mm diameter by 0.8 mm height with 150 μm pores) were printed for water uptake and as cell culture scaffolds.

Clinically viable bone graft technologies should promote bone healing in which newly formed bone can bridge the injury with an integrated network of stable, mineralized bone tissue that is well vascularized and continuous like undamaged tissue. If bone tissue does not fully bridge the defect, but consists of discontinuous nodules of new bone, then it will resorb due to lack of mechanical stimulation or persist as a non-union that does not provide appropriate mechanical function to the local skeletal system. If non-mineralized fibrous tissue grows into the injury, the defect will not heal properly but will be misshapen or form a non-union. If bone tissue forms quickly but without sufficient vascular support, it will become necrotic and not heal.

Mixing TCP and HAP nano-powders with PCL revealed that HAP resulted in a composite that was highly viscous and difficult to pneumatically dispense reliably through a 200 μm nozzle. TCP allowed for the increased ceramic content to 50% of the composite weight, a 60% increase in the CaP content of related composites reported in the literature. Printed structures demonstrated greater departure from PCL properties at the 50% TCP level than at the 20% TCP level. This observation held true for surface appearance, mechanical properties, accelerated degradation response, and osteogenic differentiation influence on a stem cell population.

TABLE 1 Attempted mixtures of PCL and CaP nanopowders. Extrusion was tested through a 200 μm steel 5 nozzle from 100-150° C. CaP Ratio (wt. % CaP) Extrusion hydroxyapatite PCL/HA 9:1 (10%) No hydroxyapatite/tricalcium PCL/HA/TCP 35:3:12 (30%) No phosphate tricalcium phosphate PCL/TCP 4:1 (20%) Yes tricalcium phosphate PCL/TCP 7:3 (30%) Yes tricalcium phosphate PCL/TCP 1:1 (50%) Yes tricalcium phosphate PCL/TCP 6:4 (60%) No

After establishing printable mixtures, various structures were printed for further evaluation with respect to properties amenable to bone tissue engineering. The scanning electron micrographs of the surface (FIG. 5B) showed subtle differences, including discernment of TCP particles evident at the surface of both 20% and 50% levels. PCL and 20% TCP demonstrate what looks like polygonal grains, which seem to be disrupted or not present in the 50% TCP mixture. The 50% TCP mixture also presented a surface with irregular bumps and occasional crystal structures of fractal-like shapes. The cross section reveals a change in internal structure at the 50% TCP level with small, isolated micropores throughout the filament. Micropores ranged in diameter from roughly 5 to 25 μm.

The compressive mechanical properties of the printed structures demonstrate an improved resistance to compressive force with increased TCP content. FIG. 6 shows representative stress-strain curves of the three materials as well as the average elastic modulus and compressive strength at the yield point. Analysis shows 20% TCP to not be significantly different from neat PCL while 50% has a higher elastic modulus than both and statistically higher strength than neat PCL.

Structures were also immersed in simulated body fluid to assess surface response to the thermodynamically sensitive solution. Many materials that demonstrate good osseointegration properties also promote accretion of mineral on their surface when submerged in SBF. Morphological differences on the surfaces of the composites containing TCP were noticeable after one day in SBF. PCL surfaces do not show much evidence of mineral accretion except for occasional nucleation sites. By day 7, 50% TCP exhibits high levels of accretion with crystals growing into veritable carpet of mineral piles. PCL shows the least amount of mineral accretion at sparsely occurring nucleation sites. 20% TCP exhibits good mineral accretion but retains non-mineralized regions. Thus, 50% TCP appears to be an osteoconductive material, and in vivo results already reported support this conclusion.

Grafts were fabricated with the 50% TCP material by 3D printing on the ITOP bioprinting system with one of two designs: biomimetic Core/Shell design or control Core-only design. The biomimetic design implemented a low-porosity Shell structure surrounding the porous Core of the graft. The Shell covered areas of the graft interfaced with surrounding soft tissue. The control design consisted of the graft volume comprised of the same porous Core without a surrounding Shell. The two designs can be seen in FIG. 9.

An additional structure was fabricated to better elucidate the impact of the Shell by evaluating fibrous tissue infiltration based on pore size. A gradient of five pore sizes were fabricated: 25 μm, 50 μm, 100 μm, 300 μm, and 700 μm. The internal pores of the structure were 700 μm, and the other five faces were nonporous. After explanation from a dorsal subcutaneous pocket, structures demonstrated a transition from fibrous interface formation over the pores to ingrowth with 100 μm pore size facilitating the transition. Therefore, the Shell design incorporated a pore size less than 50 μm.

CT imaging allows visualization of the newly formed bone in each graft. With the aid of analysis software, the new bone can be modeled in 3D and visualized. Implanted grafts were followed post-op by CT every two weeks. This study involved 20 rabbits total, 10 per graft type. The Core region was segmented in Mimics to track the bone healing within the graft. Visual analysis revealed bone healing in both grafts, but of different quality. Bone healing in the control design evinces osseointegration but did not fill the shape of the graft, while the biomimetic design guided the bone to fill in the entire Core of the graft. The segmented data was used to produce 3D models to better visualize the different healing patterns. The bone tissue forming within the control graft had a U-shape, which is commonly seen in this type of defect when left untreated. The biomimetic graft healing pattern is slightly different in each individual; however, it filled in the Core of the graft.

The software allowed for metadata extraction from the segmentation masks. The average radiodensity of the Core region of each graft at each time point was plotted and averaged (FIG. 11). The average radiodensity of the new bone tissue within the Core regions was also plotted. The Core region was also mirrored to the same region on the contralateral mandible of several individuals (n=4) and averaged to give a positive control value. New bone within the control graft was more opaque on average, while both designs approach normal levels of bone density at 12 weeks post-op.

Graft filling was also assessed by how much of the Core region contained new bone tissue on each CT slice through the graft. FIG. 10 plots the percentage of Core area filled with new bone along the long axis of the defect. This plot shows that the Shell guides new bone to fill in between 60 and 90% of the Core in the biomimetic graft while the control graft is filled between 30 and 70% with a consistent minimum in the center of the graft.

CT data indicates that new bone tissue in both grafts is maturing over time as the radiodensity of the new bone increases with time. Histology also confirms the maturation of bone tissue over time. Sections of new bone tissue at the 4-week time point show some lamellar osteocyte and ECM organization but also have significant amounts of osteoid and active osteoblasts. By the 12-week time point, the osteoid is largely absent, while the areas of lamellar organization increased.

Histology also reveals that dense fibrous tissue forms an interface with newly forming bone in the control graft. The same feature is absent in biomimetic grafts, indicating that the Shell is functioning to resist fibrous tissue in-growth. New bone grows into the large pores of the Core architecture, space kept available by the Shell.

An interesting and unexpected result is the fact that newly-formed bone in the control graft registered as more radiodense than the bone in the biomimetic graft until the last time points. The shape of the radiodensity curves also indicates that healing in the control graft plateaus within the timeframe of the study, while healing in the biomimetic graft remains linear. The control graft may have reached maximum bone healing, while the biomimetic graft has not.

Together, these results are encouraging. High quality bone healing in a critically-sized defect was achieved within three months without introduction of biologics like stem cells or growth factors. However, the addition of biologics may still be desirable for some applications, and the ITOP platform on which this study was done is capable of incorporating many other design features like cell-laden hydrogels, growth factors, vascular cells patterned to form vessels, other skeletal tissue components like muscle, tendon/ligament, or cartilage.

A graft was devised that could be fabricated on this platform in a patient specific manner through computer aided design and computer aided manufacturing software. CT images from a clinical scanner were processed with a set of software packages. The software allowed for a complex graft to be designed and fabricated for in vivo implantation and further non-destructive analysis via CT follow up. The graft design, fabrication and analysis process enabled a study looking at the impact of implementation of a biomimetic Core/Shell design to a critically sized defect without other grafting material packing the defect. Results of this study demonstrate that graft design elements have an impact on the quality of bone healing beyond the type of materials used. By printing a contoured low porosity Shell around the outer edge of the graft where surrounding soft tissues would be in contact with it, the bone formation within the porous Core of the graft was significantly improved. Critically-sized defects over 1 cm in length and 1 cm depth were healed by 12 weeks post-op without the inclusion of growth factors or other stimulating factors.

The foregoing is illustrative of the present invention, and is not to be construed as limiting thereof. The invention is defined by the following claims, with equivalents of the claims to be included therein. 

That which is claimed is:
 1. A composition comprising, consisting of or consisting essentially of: a biocompatible polymer; and a biocompatible ceramic, wherein said biocompatible polymer and said biocompatible ceramic are present in said composition at a ratio of from 3:1 to 1:3 of biocompatible polymer:biocompatible ceramic by weight, wherein said composition comprises a composite of said biocompatible polymer and said biocompatible ceramic, said composite having improved printability and/or having an improved elastic modulus and/or improved stress at failure, as compared to a blend of said biocompatible polymer and said biocompatible ceramic, and wherein said composition comprises less than 10, 5, 3, 1, 0.5, or 0.1% of solvent by weight.
 2. The composition of claim 1, wherein said biocompatible ceramic is tricalcium phosphate (TCP).
 3. The composition of claim 1, wherein said biocompatible polymer is polycaprolactone (PCL).
 4. The composition of claim 1, wherein said biocompatible polymer and said biocompatible ceramic are present in said composition at a ratio of from 2:1 to 1:2 of biocompatible polymer:biocompatible ceramic by weight.
 5. The composition of claim 1, wherein said biocompatible polymer and said biocompatible ceramic are present in said composition at a ratio of from 1.5:1 to 1:1.5 of biocompatible polymer:biocompatible ceramic by weight.
 6. The composition of claim 1, wherein said composition is provided as a filament useful for fused deposition modeling (FDM) three-dimensional printing.
 7. The composition of claim 6, wherein said filament is provided on a spool.
 8. The composition of claim 1, wherein said composition is provided as a powder or pellets useful for fused deposition modeling (FDM) three-dimensional printing.
 9. The composition of claim 8, wherein said powder or pellets is provided in a cartridge.
 10. The composition of claim 1, wherein the composite of polymer and ceramic has an internal microporous structure.
 11. The composition of claim 1, wherein the composite of polymer and ceramic as a 4 mm cube with 0.8 mm pores has an elastic modulus of from 15 to 30 MPa under compressive loading.
 12. The composition of claim 1, wherein the composite of polymer and ceramic has an accelerated degradation as compared to a composite having a higher ratio of biocompatible polymer:biocompatible ceramic.
 13. The composition of claim 1, wherein the composite of polymer and ceramic has increased water uptake as compared to a composite having a higher ratio of biocompatible polymer:biocompatible ceramic.
 14. A medical implant composition comprising a composition of claim 1, wherein said implant comprises: a porous core region; and a non-porous outer shell layer surrounding at least a portion of said core region.
 15. The medical implant composition of claim 14, wherein said porous core region comprises interconnected pores having an average diameter of from 400 microns to 1,000 microns; and said non-porous outer shell layer comprises average pore sizes of less than 50 microns.
 16. The medical implant composition of claim 14, wherein said implant is a bone implant.
 17. The medical implant composition of claim 14, wherein said implant is a cartilage implant.
 18. The medical implant of claim 14, wherein the non-porous outer shell layer is customized to be received in a bone or cartilage defect of a patient based upon scan data.
 19. A method of making a medical implant, said method comprising printing the composition of claim 1 as a scaffold.
 20. The method of claim 19, wherein said printing comprises melt extrusion such as fused deposition modeling.
 21. The method of claim 19, wherein said printing comprises melt extrusion such as fused deposition modeling through a nozzle that is from 50 microns to 300 microns in size.
 22. The method of claim 19, wherein said method comprises co-printing a composition comprising cells in a biocompatible carrier onto the scaffold.
 23. A method of treating a bone or cartilage defect or injury in a subject in need thereof, comprising implanting the medical implant composition of claim 14 into the subject in a treatment-effective configuration.
 24. The method of claim 23, wherein the bone or cartilage defect or injury is a bone fracture. 